Folic acid: The super vitamin

FOLIC acid is the synthetic version of folate (vitamin B9) and is a very important vitamin that works together with vitamin B12, which is essential for the body to make and repair DNA, RNA, the proteins needed for cell division, and red blood cell production.

In fact, folic acid is included in the World Health Organization’s list of essential medicines, which are the most effective and safe medicines needed in a health system. The daily required amount of folate in adults is 400 micrograms, and this increases by an additional 400mcg in pregnancy and breastfeeding.

Dr Anna-Kay Taylor Christmas, obstetrician-gynaecologist (ObGyn) said folates occur naturally in many foods, with the highest levels in liver and dark green leafy vegetables like callaloo, pak choi, broccoli and spinach, and is also found in legumes and beans like chickpeas, lentils, red peas and pigeon peas, some fruits, dairy products, poultry and meat, eggs, seafood and grains.

In addition, the ObGyn pointed out that folate is water soluble and easily destroyed by cooking, so the best way to prepare these vegetables is raw or lightly cooked in the microwave, or by steaming.

Further, Dr Taylor Christmas noted that some countries such as Australia and Canada have made it mandatory to add folic acid to grain products such as flour, pasta, cereals and bread as a public health measure to help supplement the population. She added that the risk of toxicity from folic acid is low, because folate is a water-soluble vitamin and is regularly removed from the body through urine.

Locally, Dr Taylor Christmas said access to folate should not be problematic as Jamaica is a tropical island with an abundance of fruits and vegetables which should provide enough folate; however, an increasingly westernised diet with higher levels of fast and junk foods high in salt and unsaturated fats and low in nutrients has begun to affect the population, leading to folate deficiency.

“Folate deficiency can be caused by poor diets that do not include enough fruits and vegetables but may also be caused by diseases of the digestive system that affect its absorption, as well as certain medicines that block its formation or action. Folate deficiency is also accelerated by alcohol consumption. Folate levels in your body can become low in just a few weeks if you don’t eat enough folate-rich foods,” she explained.

The ObGyn also said that though folate is a super vitamin, if deficient in women, it can lead to neural tube defects in newborns as well as heart defects.

“The neural tube is what forms the spinal column as the baby is developing and abnormalities occur during the first few weeks of pregnancy, sometimes before the woman even knows she is pregnant. Spina bifida is one of the most common defects babies are born with in the western world and causes an incomplete closing of the backbone and membranes around the spinal cord, which can cause difficulties with walking, muscle control, control of the bladder and bowels and excess fluid around the brain. This often requires intense and expensive therapy, and even surgery to try to correct it, with varying degrees of success depending on the severity of the defect,” Dr Taylor Christmas said, adding that it is recommended that women who are thinking about or trying to get pregnant start folate supplements of at least 400mcg daily one to two months before actively trying to conceive.

With regards to supplements, Dr Taylor Christmas said some women have an increased risk of neural tube defects or folic acid deficiency in pregnancy and so are prescribed higher doses of folic acid supplementation of 5mg daily to compensate for this.

“This includes if they or their partner have a neural tube defect or a family history of defects, if there was a previous pregnancy with a neural tube defect, if they have diabetes, or are on anti-epileptic medication. Women with sickle cell disease are also given higher doses of folic acid to prevent deficiency in pregnancy,” she said.

The ObGyn said folate is also very important for fertility in men and women.

“It is an essential component of sperm formation and may contribute to subfertility if there is a deficiency. In addition, abnormalities in the genes of enzymes involved in folate metabolism may also contribute to fertility complications in women with unexplained infertility,” she said.

Dr Taylor Christmas also pointed out that folate is heart healthy, and some studies have shown a link between folate-rich diets or supplementation and decreased risk of cardiovascular disease and stroke.

Additionally, because folate is an essential component of blood cell formation, Dr Taylor Christmas said deficiency can cause a form of anaemia that can lead to mouth sores, a swollen, tender tongue, fatigue, weakness, shortness of breath, depression, confusion, hair changes (greying) and poor growth in children.

She added that folic acid is a simple, inexpensive nutrient that is easy to obtain through diet or supplementation and as a result no one should be suffering from the effects of folate deficiency in 2018.